Cardiology

Packer, M. (2016). “Data sharing: Lessons from copernicus and kepler.” Bmj 354: i4911.

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To understand the workings of science, pick up a copy of De Revolutionibus Orbium Coelestium. Published with great reluctance by the astronomer Nicolaus Copernicus in 1543, the book puts forth a compelling argument for a heliocentric universe. Turn the pages and you will see the book is filled with data. Whose data? Copernicus relied on the data collected by others in addition to his own to formulate his revolutionary theory. Publication of these data subsequently allowed Johannes Kepler to identify discrepancies, which led to his innovative proposal in 1605 that the planets moved in an ellipse (rather than in a circle), an idea that he had previously assumed to be too simple for earlier astronomers to have overlooked. Of course, Kepler presented his data at the same time that he published his conclusions. In contrast, Tycho Brahe (who opposed Copernicus) famously withheld his astronomical data from Kepler because he knew they could be used to confirm Copernicus’s heliocentric model.

McCullough, P. A., J. P. Choi, G. A. Feghali, J. M. Schussler, R. M. Stoler, R. C. Vallabahn and A. Mehta (2016). “Contrast-induced acute kidney injury.” J Am Coll Cardiol 68(13): 1465-1473.

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Coronary angiography and percutaneous intervention rely on the use of iodinated intravascular contrast for vessel and chamber imaging. Despite advancements in imaging and interventional techniques, iodinated contrast continues to pose a risk of contrast-induced acute kidney injury (CI-AKI) for a subgroup of patients at risk for this complication. There has been a consistent and graded signal of risk for associated outcomes including need for renal replacement therapy, rehospitalization, and death, according to the incidence and severity of CI-AKI. This paper reviews the epidemiology, pathophysiology, prognosis, and management of CI-AKI as it applies to the cardiac catheterization laboratory.

Cedars, A. M., S. Burns, E. L. Novak and A. P. Amin (2016). “Predictors of rehospitalization among adults with congenital heart disease are lesion specific.” Circ Cardiovasc Qual Outcomes 9(5): 566-575.

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BACKGROUND: Readmission is responsible for a large proportion of inpatient care costs in adult congenital heart disease. There are, however, few data available to identify at-risk patients or to suggest strategies for intervention to prevent rehospitalization. METHODS AND RESULTS: We conducted an analysis of admissions in patients over the age of 18 years with a 3-digit International Classification of Diseases-Ninth Revision code of 745 to 747 from the State Inpatient Databases of Arkansas (2008-2010), California (2003-2012), Florida (2005-2012), Hawaii (2006-2010), Nebraska (2003-2011), and New York (2005-2012). We investigated index admission diagnoses most commonly associated with 1-year readmission and the most common reasons for readmission. We then selected variables we thought would be associated with increased rates of 1-year readmission and constructed multivariable regression models grouping patients by congenital lesion, to examine the relative contribution of the specified variables to readmission risk for each lesion. A total of 64 420 patients were included in the final analysis. Thirty-nine percent of patients experienced a readmission within 12 months of an index admission. Compared with those who did not experience a readmission, those who did were more likely to have had a primary diagnosis of congestive heart failure at the time of index admission, and the most common diagnoses at the time of readmission were congestive heart failure and arrhythmia. There is lesion-specific heterogeneity in risk factors for readmission. CONCLUSIONS: Patients with adult congenital heart disease have high rates of readmission, predominantly for congestive heart failure and arrhythmia. Predictors of readmission are lesion specific, and future strategies aimed at decreasing readmission rate will likely need to be individualized.

Solomon, S. D., B. Claggett, M. Packer, A. Desai, M. R. Zile, K. Swedberg, J. Rouleau, V. Shi, M. Lefkowitz and J. J. McMurray (2016). “Efficacy of sacubitril/valsartan relative to a prior decompensation: The paradigm-hf trial.” JACC Heart Fail 4(10): 816-822.

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OBJECTIVES: This study assessed whether the benefit of sacubtril/valsartan therapy varied with clinical stability. BACKGROUND: Despite the benefit of sacubitril/valsartan therapy shown in the PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial, it has been suggested that switching from an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker should be delayed until occurrence of clinical decompensation. METHODS: Outcomes were compared among patients who had prior hospitalization within 3 months of screening (n = 1,611 [19%]), between 3 and 6 months (n = 1,009 [12%]), between 6 and 12 months (n = 886 [11%]), >12 months (n = 1,746 [21%]), or who had never been hospitalized (n = 3,125 [37%]). RESULTS: Twenty percent of patients without prior HF hospitalization experienced a primary endpoint of cardiovascular death or heart failure (HF) hospitalization during the course of the trial. Despite the increased risk associated with more recent hospitalization, the efficacy of sacubitril/valsartan therapy did not differ from that of enalapril according to the occurrence of or time from hospitalization for HF before screening, with respect to the primary endpoint or with respect to cardiovascular or all-cause mortality. CONCLUSIONS: Patients with recent HF decompensation requiring hospitalization were more likely to experience cardiovascular death or HF hospitalization than those who had never been hospitalized. Patients who were clinically stable, as shown by a remote HF hospitalization (>3 months prior to screening) or by lack of any prior HF hospitalization, were as likely to benefit from sacubitril/valsartan therapy as more recently hospitalized patients.

Mack, M. and D. Holmes (2016). “Bioprosthetic valve thrombosis: The harder one looks, the more one finds.” J Thorac Cardiovasc Surg 152(4): 952-953.

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The desire to avoid anticoagulation after surgical aortic valve replacement (SAVR) has been one of the major drivers toward the greater use of bioprosthetic valves and less use of mechanical valves so that more than 90% of surgical valves now implanted are tissue. Recently concerns have been raised about the occurrence of bioprosthetic valve thrombosis (BPVT) and its possible relationship to subsequent structural valve deterioration.1 Recent studies done with sophisticated imaging techniques, including 4-dimensional computed tomography (4D CT) with high-speed scanners have clearly documented leaflet immobility, thickness, and thrombosis both early and late after both SAVR and transcatheter aortic valve replacement (TAVR) procedures (Figure 1).2 Although the true incidence and clinical relevance of these different findings are as yet unknown, it is clear that the phenomenon is more common than was previously appreciated.3